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Teen Angst or Anxiety Disorder?

How to tell if your teen needs help

Malia Jacobson

Published on: March 13, 2020

teen girl sitting on the couch with her head in her arms

Editor's note: This article was sponsored by THIRA Health.

More teenagers are struggling with anxiety these days, yet treatment rates remain low. Over the past 10 years, diagnoses for anxiety disorders, including generalized anxiety disorder (GAD), social anxiety, panic disorders and phobias, have increased 17 percent among young people. But anxiety in teens is often minimized or ignored and most don’t receive treatment: Only 1 percent get help in the same year their symptoms begin, and 80 percent never get help, according to the Child Mind Institute.

One reason too few teens get help for anxiety is that parents and caregivers think mood swings, outbursts and excessive anxiety are normal for teens, even when these behaviors interfere with school, relationships and family life. Here’s how to tell the difference between normal teen angst and problematic anxiety, and to know when to seek help for your teen.

What’s behind the trend

First, it’s important to view the spike in anxiety in context, says Mehri Moore, M.D., chief medical officer and founder of THIRA Health, a mental health treatment center for girls and women in Bellevue. While it’s true that more youths seem to be experiencing anxiety disorders, the increase may not be as dramatic as it seems. Anxiety disorders have long been common for adults, says Moore. “Anxiety is more prevalent than other mental health conditions, and about 20 percent of people will have an anxiety disorder at some point in their lives, and rates are higher for females.”

Today, more young people are being diagnosed with these disorders, in part because the mental health field has become better at discovering and treating mental health conditions in children and teenagers, says Moore. In other words, excessive anxiety isn’t necessarily a new problem for teens.

Yet, better diagnostics aside, there are factors that may be contributing to a rise in anxiety for adolescents, says Moore. Increasing use of technology and social media seems to fuel anxiety, particularly for those kids already prone to experiencing anxious thoughts.

Today’s teenagers get constant input about something as critical to their identity as social belonging, fueling anxiety that teenagers growing up a couple of decades ago never had to deal with. When teens constantly check their phone, they’re really affirming their popularity and sense of belonging, Moore notes. “Social media has really changed everything.”

When is anxiety a problem?

Everyone experiences anxiety and worry, says Moore. “It’s normal and part of the human condition.” For adolescents, rapid physical, social and hormonal changes align with shifts in emotions, hence the mood swings and “teen angst” we associate with the adolescent years.

So, it’s normal for teens to display a wide range of moods and emotions on any given day. Phases of increased stress or sadness are common, too, especially for teens experiencing changes or a loss, such as a move, a breakup or a change in family status (e.g., their parents’ divorce). When changes in mood or behavior last longer than six months, it’s an indication that a teen may have an anxiety disorder.

It’s about getting the teen to think a little bit differently.

What kinds of changes should parents look for? Changes in eating or sleeping patterns, such as sleeping too much or waking in the middle of the night, combined with exhaustion and fatigue, can signal a problem with anxiety, Moore notes. A heightened startle response and always seeming to be “on edge” are warning signs, as are missing school frequently; withdrawing from family routines, such as mealtimes; and losing interest in friends and activities.

The sudden, unexplained onset of panic attacks is another indication of increasing anxiety. During a panic attack, teens may go pale, appear to be hyperventilating and even pass out. Some teens may experience a panic state, which mimics a panic attack but can last for hours instead of minutes, says Moore.   

Another sign that parents may miss is the “zombie” stare: when a teen seems distracted and spacey, stares through you, doesn’t seem to listen or respond. Parents may roll their eyes and write this off as normal, albeit annoying, teen behavior, but it can be a sign of an anxiety problem, says Moore. “The behavior is called dissociation, and it’s a coping mechanism. Detaching or distancing themselves from what’s going on around them is a way to function while they’re in a state of anxiety.”

Getting help

When a teen’s anxiety isn’t treated, everyone in the family is affected, notes Moore. Parents may clash over how to respond to the teen’s behavior, siblings may resent the attention given to their anxious sibling, and everyone has to deal with sudden changes in family plans or routines, says Moore. “The family can quickly move from a functional state to a dysfunctional state. The whole family’s life can become centered around avoiding situations that bring on the teen’s anxiety, and it really becomes a family problem.”

The first step is talking to your teen’s pediatrician, who can help determine if underlying factors might be contributing to anxiety. From there, the provider can recommend a therapist who specializes in youth and anxiety. Although some anxious teens benefit from antidepressant medication, many can alleviate anxiety by working with a trained therapist.

Cognitive behavioral therapy, or CBT, is a type of talk therapy that’s proven to help teens struggling with anxiety, says Moore. “It’s about getting the teen to think a little bit differently, which then affects behavior.”

“Teens with anxiety also may benefit from learning specific skills to help manage anxiety and cope with stress and worry before it gets out of control,” says Kathryn Korslund, Ph.D., clinical director of THIRA Health. “Such skills are at the forefront of dialectical behavior therapy, or DBT, a specialized type of cognitive behavioral therapy that focuses on helping treat the problems that interfere with teens having the life that they want.”

Sponsored by:

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